Muscular Injury Approach: Healing Phases, Conservative Treatment and Therapeutic Options
DOI:
https://doi.org/10.25759/spmfr.310Keywords:
Lacerations, Muscle, Skeletal/injuries, Wound HealingAbstract
Muscle injury is one of the most frequent pathological processes in athletes. Early diagnosis and proper approach optimizes recovery and minimizes downtime.
The healing process and muscle regeneration consists of a complex cellular and immune response with several phases and multiple biochemical processes involved: inflammatory phase, regeneration phase and remodeling phase.
The treatment of muscle injury should be serial and take into account the biological stage in which healing is found.
Pharmacological treatment of muscle injury is a controversial issue. Current therapeutic options attempt to interfere with the various stages of the healing process, either by stimulating cell regeneration or by inhibiting the formation of fibrosis. Currently either oral drugs or injectables have limited scientific evidence to be applied routinely.
This article aims to describe the phases of muscle healing in detail, to detail the approach and treatment of rehabilitation indicated in each phase and to present the evidence of several therapeutic options. For this, a review of the literature published until July of 2018 was carried out in the main medical databases.
Downloads
References
Järvinen TA, Järvinen TL, Kääriäinen M, Kalimo H, Järvinen M. Muscle injuries: Biology and treatment. Am J Sports Med. 2005;33:745-64. doi:10.1177/0363546505274714
Baoge L, Van Den Steen E, Rimbaut S, Philips N, Witvrouw E, Almqvist KF, et al. Treatment of skeletal muscle injury: a review. ISRN Orthop. 2012;2012:1-7. doi:10.5402/2012/689012
Yang W, Hu P. Skeletal muscle regeneration is modulated by inflammation. J Orthop Transl. 2018;13:25-32. doi:10.1016/j.jot.2018.01.002
Delos D, Maak TG, Rodeo SA. Muscle injuries in athletes: enhancing recovery through scientific understanding and novel therapies. Sports Health. 2013;5:346-352. doi:10.1177/1941738113480934
Kerkhoffs GM, van Es N, Wieldraaijer T, Sierevelt IN, Ekstrand J, van Dijk CN.. Acute hamstring injuries – diagnosis and prognosis. Knee Surg Sports Traumatol Arthrosc. 2013;21:500-9. doi: 10.1007/s00167-012-2055-x.
Mosca MJ, Rodeo SA. Platelet-rich plasma for muscle injuries: game over or time out? Curr Rev Musculoskelet Med. 2015;8:145-53. doi:10.1007/s12178-015-9259-x
Kaar JL, Li Y, Blair HC, Asche G, Koepsel RR, Huard J,et al. Matrix metalloproteinase-1 treatment of muscle fibrosis. Acta Biomater. 2008;4:1411-20. doi:10.1016/j.actbio.2008.03.010
Wong S, Ning A, Lee C, Feeley BT. Return to sport after muscle injury. Curr Rev Musculoskelet Med. 2015;8:168-15. doi:10.1007/s12178-015-9262-2
Balius R, Pedret C. Lesiones Musculares En El Deporte. Madrid: Panamericana EMe ; 2013.
Danna NR, Beutel BG, Campbell KA, Bosco JA. Therapeutic approaches to skeletal muscle repair and healing. Sports Health. 2014;6:348-55. doi:10.1177/1941738113512261
Hotfiel T, Seil R, Bily W, Bloch W, Gokeler A, Krifter RM, et al. Nonoperative treatment of muscle injuries - recommendations from the GOTS expert meeting. J Exp Orthop. 2018;5:24. doi:10.1186/s40634-018-0139-3
Ackerman KE, Babwah T, Bahr R. F-MARC Football Medicine Manual. 2nd. ed. Zurich: FIFA Medical Committee; 2009.
Wilkin LD, Lekan JM, Robinson LE, Devor ST. Influence of therapeutic ultrasound on skeletal muscle regeneration following blunt contusion. Med Sci Sport Exerc. 2003;35:S108. doi:10.1097/00005768-200305001-00588
Rahusen FT, Weinhold PS, Almekinders LC. Nonsteroidal anti-inflammatory drugs and acetaminophen in the treatment of an acute muscle injury. Am J Sports Med. 2004;32:1856-9. doi:10.1177/0363546504266069
Paoloni JA, Milne C, Orchard J, Hamilton B. Non-steroidal antiinflammatory drugs in sports medicine: Guidelines for practical but sensible use. Br J Sports Med. 2009;43:863-5. doi:10.1136/bjsm.2009.059980
Brock J, Golding D, Smith PM, Nokes L, Kwan A, Lee PY Update on the role of actovegin in musculoskeletal medicine : a review of the past 10 years. Clin J Sport Med. 2018(in press). doi: 10.1097/JSM.0000000000000566.
Bernardo DNA, Bryk FF, Fucs PM de MB. Influence of nitric oxide in the improvement of muscle power. Acta Ortopédica Bras. 2015;23:294-8. doi:10.1590/1413-785220152306148249
Fukushima K, Badlanu N. The use of an antifibrosis agent to improve muscle recovery after laceration. Am J Sports Med. 2001;29:394-402
Chan YS, Li Y, Foster W, Fu FH, Huard J. The use of suramin, an antifibrotic agent, to improve muscle recovery after strain injury. Am J Sports Med. 2005;33:43-51. doi:10.1177/0363546504265190
Nozaki M, Yong Li, Jinhong Zhu, Ambrosio F, Uehara K, Fu FH, et al. Improved muscle healing after contusion injury by the inhibitory effect of suramin on myostatin, a negative regulator of muscle growth. Am J Sports Med. 2008;36:2354-62. doi:10.1177/0363546508322886
Bedair H, Karthikeyan T. Angiotensin II receptor blockade administered after injury improves muscle regeneration and decreases fibrosis in normal skeletal muscle. Am J Sport Med. 2008;36:1548-54. doi:10.1177/0363546508315470
Kobayashi T, Uehara K, Ota S, Tobita K, Ambrosio F, Cummins JH, et al. The timing of administration of a clinically relevant dose of losartan influences the healing process after contusion induced muscle injury. J Appl Physiol. 2013;114:262-73. doi:10.1152/japplphysiol.00140.2011
Kelc R, Vogrin M. Corrigendum to “Concerns about fibrosis development after scaffolded PRP therapy of muscle injuries: Commentary on an article by Sanchez et al.: ‘Muscle repair: Platelet-rich plasma derivates as a bridge from spontaneity to intervention.’”. Injury. 2015;46:1424. doi:10.1016/j.injury.2015.03.031
Bennett MH, Best TM, Babul-Wellar S, Taunton JE. Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane Database Syst Rev. 2005;4. doi:10.1002/14651858. CD004713.pub2
Dutt V, Gupta S, Dabur R, Injeti E, Mittal A. Skeletal muscle atrophy: Potential therapeutic agents and their mechanisms of action. Pharmacol Res. 2015;99:86-100. doi:10.1016/j.phrs.2015.05.010
Downloads
Published
How to Cite
Issue
Section
License
Copyright statement
Authors must also submit a copyright statement (as seen below) on article submission.
To the Editor-in-chief of the SPMFR Journal:
The below signed author(s) hereby state that the article
________________________________________ (ref. MFR_________) is
an original unpublished work and all facts stated are a product of the author(s) investigation. This article does not violate any copyright laws or privacy statements. The author(s) also hereby confirm that there is no conflict of interest's issues in this article.
By submitting this article the author(s) agree that after publication all copyrights belong to the SPMFR Journal.
Signed by all authors
Date:
Names (capital letters):
Signatures:
The SPMFR Journal’s contents are follow a Creative Commons licence. After publication the authors can hand out the articles as long as the SPMFR Journal is credited.